Charge Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Job Title

Responsible for account-level pre-bill charge verification to ensure accurate, complete, and compliant claim construction before final billing. This role focuses on identifying and correcting charge capture issues such as missing CPT/HCPCS codes, incorrect CPT/HCPCS selection, unit/revenue code discrepancies, and documentation-to-charge mismatches. This position has targeted operational responsibility for pre-bill reviews. The specialist partners with clinical departments, coding, billing, and revenue integrity leadership to resolve charge defects and reduce preventable revenue leakage.

Minimum Requirements

Education: High school diploma or equivalent required. Associate degree in healthcare, business, nursing, health information, or related field preferred.

Experience: Three years' experience in hospital revenue cycle, charging, billing edits, charge capture, or related function required. Experience with pre-bill account review and correction workflows preferred. Experience with Medicare and Managed Medicare claim requirements preferred. Procedural area experience (OR, Cath Lab, IR, imaging, cardiology, etc.) preferred.

Other Credentials: Knowledge and Skills: Strong understanding of hospital charge capture and claim flow dependencies. Working knowledge of CPT/HCPCS, revenue codes, modifiers, and unit-based charging concepts. Ability to reconcile documentation, itemized charges, and expected services performed. Strong analytical, organizational, and follow-through skills. Effective written and verbal communication across clinical and operational teams

Special Training: Proficiency with EHR/revenue cycle systems, charging work queues, and account review tools. Proficiency in Excel and standard reporting/issue tracking tools

Mental, Behavioral and Emotional Abilities: Ability to work independently as well as a team player. Ability to complete assignments within prescribed accuracy parameters and deadlines.

Essential Functions

Performs account-level pre-bill charge integrity review for designated populations.

Identifies charge defects including missing CPT/HCPCS, incorrect procedure codes, missing/incorrect modifiers, unit discrepancies, and revenue code inconsistencies.

Reconciles charges to supporting documentation (for example procedural notes, implant/device logs, ancillary documentation, and departmental records).

Validates that itemized charges align to services actually performed and documented before claim finalization.

Initiates and tracks charge corrections through established pathways (for example correction work queues, department outreach, and billing correction tools).

Applies hold/release criteria for unresolved high-risk charging issues prior to claim submission.

Communicates required corrections and supporting rationale to billing, coding, and clinical department contacts within defined turnaround expectations.

Documents issue category, root cause, action taken, and final disposition in designated tracking systems.

Performs follow-up on open correction items to ensure closure within policy and timely filing limits.

Identifies recurring defect patterns by department, procedure, payer, or workflow and escalates systemic issues to Revenue Integrity leadership.

Partners with Authorization Integrity, Surgical Revenue Integrity, and CDM teams to close upstream process gaps impacting charge accuracy.

Participates in quality review activities and complies with standard work, audit requirements, and documentation standards.

Supports onboarding, cross-training, and workflow updates as assigned.

Performs other duties as assigned.

Physical Demands and Work Environment

Frequent physical demands include: Pinching/fine motor activities, Keyboard use/repetitive motion, Talk or Hear

Occasional physical demands include: Standing, Walking, Climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, Reaching forward, Reaching overhead, Squat/kneel/crawl, Wrist position deviation

Continuous physical demands include: Sitting

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing

Anticipated Occupational Exposure Risks Include the following: N/A

Benefits

This position is eligible for the following benefits:

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retirement Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits Long Term Disability (LTD)
• Disability Benefits Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• Voluntary Life Spouse
• Voluntary Life Employee
• Voluntary Life Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program